The Inner Work of Physician-Patient Relationship…And Other Things

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Help On the Path to Better

What about your eating habits is already good, that you want to maintain, that you’re proud of?

And where is there room for improvement?

Sometime in the last five years, I started querying my patients about nutrition this way. It seems to put people more at ease talking about their eating habits, for some reason. Culturally, we are so judgmental and defensive about food and eating, weight and appearance. So one day, I decided to start with the positive, and it makes the conversation easier for everybody. Fascinating!

I did not realize until the past week that this is my personal version of appreciative inquiry (AI). I have started including AI in my presentations this fall, which is very well received so far. I got feedback from the talk I gave to my design friends two weeks ago. They liked focusing on the positives of work before problem solving. This week I presented to a mixed audience of physicians, from all specialties, early career to retired, on burnout. I chose to make it similarly workshop-like, a very ambitious undertaking in 45 minutes, but we did it! In the last segment I invited audience members to identify the first step they might take to address their own sources of burnout, or improve their self-care.

One generous physician shared her plan, initially stated as, “Just commit to doing it,” talking about exercise. After a few more questions, we arrived at her actual plan: figure out what she will do (treadmill); decide how long she can carve out (30 min); find time on the calendar; write it on the calendar; know how she will be held accountable. Turns out she had already succeeded at executing–5 times a week for 20 weeks this year—STRONG WORK, MAMA! I wonder if there are other arenas where she applies this same, stepwise approach to making something better in her life, or the lives of her patients.

When I ask patients what needs to happen to improve their health, we inevitably start at the abstract (“Just Do It”) and must work to get to the concrete, granular action steps that will actually result in successful behavior change. It’s gratifying for both of us to arrive at a plan that the patient him/herself has an active hand in creating. Then s/he feels ultimate ownership and agency to execute.

These days I also always ask about help. Who else can keep you on track? Can your spouse eat healthier with you? Can your assistant eliminate junk food from lunch meetings? Can your kids be your food police? My best friend in college agreed to do this for me our junior year, and I lost all of my freshman fifteen, God bless him (and yes, we are still friends). When we go shopping and I look tempted to buy yet more of something I already have piles of, my daughter asks, “Do you want me to be your conscience?” Usually I reply with a hedonist, “No,” but I’m always grateful for the offer, and it does make me think twice.

Often patients return the next year living healthier in one way or another. Sometimes the plan works; many times they find another way. Sometimes plans are executed and then derailed. So we get to work on a new plan, asking all the same questions over again. It doesn’t have to be a slog! It’s just what we’ gotta do—keep getting help on the path to better. It’s my privilege to serve as helper.

These last two weeks (months?), I’m definitely not sleeping enough. Exercise is hit or miss. Eating is pretty erratic and unhealthy. Stress ebbs and flows with travel and events. But my relationships are thriving and I’m doing some seriously fun and amazing sh*t. Next year maybe the eating and workouts will be on autopilot and I’ll have to lean on folks to get through rough times. The path to better always gets blocked, takes detours, and makes us reroute. Those twists and turns are so much more fun, and we notice so much more beauty that we might otherwise miss, when we take them with good friends, no? I’m so grateful to have such loving help on the journey, and also honored to offer it. Onward.